Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists · 2009
Recurrent laryngeal nerve injury following uncomplicated carotid angioplasty and stenting.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Ошибки и ограничения
История · было → стало
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Jeyabalan Geetha, Golla Suman, Makaroun Michel, Chaer Rabih
Аннотация
PURPOSE: To describe a unique instance of cranial nerve injury related to uncomplicated carotid artery stenting (CAS).
CASE REPORT: A 74-year-old woman with a history of expressive aphasia and right upper/lower extremity weakness underwent staged CAS procedures under local anesthesia and conscious sedation. After routine predilation with a 4-mm balloon, a tapered 7 x 10 x 30-mm Acculink stent was placed and dilated with a 5-mm balloon. At 1 month after the second procedure, the carotid stents were patent bilaterally, but the patient reported voice fatigue and hoarseness along with dysphagia to liquids that started 2 days after her second procedure. Brain scans ruled out stroke. Direct laryngoscopy showed left vocal cord paralysis and a mobile right vocal cord; computed tomography revealed adduction of the left vocal cord consistent with a left recurrent laryngeal nerve injury. Radiography did not show any evidence of stent fracture. Electromyography was suggestive of right recurrent laryngeal nerve paralysis and only mild abnormalities on the left. A repeat laryngoscopy performed 4 months after the initial evaluation revealed persistent left vocal fold paralysis and no abnormalities on the right. The patient was referred for voice therapy; at 18 months, the stents were patent, and her vocal symptoms had significantly improved.
CONCLUSION: While minimally invasive endovascular techniques evolve for management of vascular disease, the anatomical structures at risk during open procedures may be injured with endovascular approaches as well.
CASE REPORT: A 74-year-old woman with a history of expressive aphasia and right upper/lower extremity weakness underwent staged CAS procedures under local anesthesia and conscious sedation. After routine predilation with a 4-mm balloon, a tapered 7 x 10 x 30-mm Acculink stent was placed and dilated with a 5-mm balloon. At 1 month after the second procedure, the carotid stents were patent bilaterally, but the patient reported voice fatigue and hoarseness along with dysphagia to liquids that started 2 days after her second procedure. Brain scans ruled out stroke. Direct laryngoscopy showed left vocal cord paralysis and a mobile right vocal cord; computed tomography revealed adduction of the left vocal cord consistent with a left recurrent laryngeal nerve injury. Radiography did not show any evidence of stent fracture. Electromyography was suggestive of right recurrent laryngeal nerve paralysis and only mild abnormalities on the left. A repeat laryngoscopy performed 4 months after the initial evaluation revealed persistent left vocal fold paralysis and no abnormalities on the right. The patient was referred for voice therapy; at 18 months, the stents were patent, and her vocal symptoms had significantly improved.
CONCLUSION: While minimally invasive endovascular techniques evolve for management of vascular disease, the anatomical structures at risk during open procedures may be injured with endovascular approaches as well.